¿Qué es la Gastritis?

What is gastritis? Hello, how are you? Welcome back! Well, today from Fundidora Park in Monterrey, we present the subject of gastritis. Why? Because no one should ever live with gastritis and acidity, so check up on yourselves in these times. Don’t forget to write any doubt in the comments and here we go: What is gastritis? Let’s see then what gastritis is since this illness affects so many of us. Gastritis is basically when the mucus, the most inner part of our stomach suffers damage. This damage produces as a response an inflammatory reaction, like we already saw in the “Inflammation and Pain” video. I’ll leave you the link up here. So, something damages it, and this mucus swells, and this inflammation of the stomach mucus can also affect the esophagus in some circumstances. Of course, if this damage lasts for a long time, it can irritate and cause erosions, which we’ll see further along, and can even cause bleeding to happen. Meaning the damage can be so large that the blood vessels get destroyed too, and we start bleeding into our stomach. In fact, 80% of digestive tract bleedings, especially upper digestive tract bleedings, are associated to gastritis, mainly when it lasts a long time and it becomes chronic gastritis. This causes this illness to become a very common cause of morbidity, many of us have it, many of us have these symptoms, sometimes in a frequent manner, we can have abdominal pain, we can have abdominal distension, nausea, diarrhea, sometimes acid reflux, the feeling of food coming back up, or some heartburn. And while most of us have these manifestations and symptoms every once in a while, this is an important cause and we need to check it, because it can lead to very important complications, one of the main ones being the bleeding. This bleeding, of course, if not stopped, can lead to a big blood loss, literally like if it were a gun shot, and leading to exsanguination, only internal, it can also lead to losing blood chronically, meaning every day we lose a little of it, and it becomes an important cause of anemia, and besides the blood loss, as we’ll see further, it can lead to certain types of cancer. Be it stomach cancer, especially associated to the Helicobacter pylori bacteria, but also esophagus cancer. The latter one in the event that we start damaging the esophagus and this causes inflammatory damage of the esophagus, but acid reflux and esophagitis we’ll get to see in a specific video. What causes it? What’s the main cause or how does this process work? Well, we all know that we eat, the food passes through the esophagus, it’s driven and from here it goes to the stomach after passing through a sphincter, which is a part of muscle that opens and closes, to only allow the food to enter the stomach and it can’t go up. This is, of course in ideal conditions. Once it’s in the stomach, the latter one activates, and starts liberating a great amount of substances to digest these nutrients, meaning it passes from being a complete burger to tiny proteins, tiny carbohydrates, tiny lipids, that afterwards will pass to the small intestine, to be absorbed and they pass into the bloodstream, so that we can use them in whatever we need them, and lastly they pass into the large intestine to be transformed into fecal matter. That’s the general nature of our digestive system. Let’s do then a little close-up to the stomach. How is it that the stomach has these functions? This is our stomach, the food went in through here, it enters in this big part called the fundus, and then comes the body, the pyloric antrum, and then the pylorus, which is the thing connecting with the small intestine (or duodenum). When the food comes in, the part that receives it, or where it falls, is precisely the mucus, the innermost part of the stomach, the part that is in front of the lumen, where the food will be. And so, we have these little holes here, or foveolae, these holes are glands inherent to the stomach and they are covered with cells that correspond to the mucus, all of these here are mucus cells. And like the name says, their main job will be to produce mucus. Along with this mucus, it will liberate substances; we’ll see which in a bit, which are in charge of digestion, and here, in the lower part, very important, it will also have these blood vessels. These blood vessels will provide all the nutrients so that all the mucus cells can do their function. So they provide oxygen, they provide food; they provide acid in case it’s needed, or bicarbonate to neutralize acid. This relationship between the blood vessels and our mucus cells will be essential in this pathology called gastritis. Just right here, in this interaction is where the pathology happens, from here on up. And this pathology, this gastritis affects of course the stomach; however, all these irritants, and all these acids, we’ll see, can also cause trouble in the duodenum, the first portion of the intestine, a lot of times creating ulcers, little afthae or lacerations in our mucus, and even bleeding, and it can also go back to the last section of the esophagus, the one connecting esophagus and stomach. In this way, many times gastritis is associated with esophageal issues and problems with the intestine or duodenum because of this proximity. So, how does this work? We have these mucus cells, and we established that when they are in contact with food, they liberate substances to digest. The most important substances will be the acid, which will be hydrochloric acid, and some proteins called proteases that are like chemical knives that cut the proteins in tiny, tiny pieces; besides those there are others which come from saliva and other places, that help us digest carbohydrates, and which will help us digest fats. And then, all of these, mainly hydrochloric acid and proteases, will undo our burger into tiny chemical pieces that we will later absorb. However, just like the burger had proteins, and has carbohydrates that get destroyed with these substances, our own mucus cells also have proteins, and they also have carbohydrates, and so, if they weren’t protected by anything, this could be really lethal for them. This production, what they produce themselves, would fall directly upon them and would destroy them really quickly; after all, hydrochloric acid is extremely acid, and if we aren’t careful, well, this would basically make a hole here and in our cells, and it would create the famous ulcer. Meaning a whole piece that dies due to these toxic substances. What does the mucus do then so this doesn’t happen and we have a healthy stomach? Well, it has many defense mechanisms. These pink cells are, again, our mucus cells. And this red thing here is the blood vessel that protects and nurtures our cells. So when the food fell in, our mucus cells take out an acid and liberated it into the light, to where the food is. That makes that where the food is, becomes extremely acid. It has a 1.5 pH or a 2 pH, meaning very acid. If we were to throw this on our hand, it would dissolve. However, at the same time, the mucus cells produce bicarbonate, and bicarbonate, of course, neutralizes the acid. And then, by producing bicarbonate so closely, and by pushing the acid further (of course, I am explaining this in a very simplified way), creates that by the time it gets there, if we are to measure pH, close to our cells, it is on a 7. That’s a very good pH. Our cells usually are a bit more basic, about a 7.2 pH. So this is a very, very good pH and that’s why the cells don’t die. Besides that, they’re going to produce mucus. So they’ll have here a series made of like carbohydrates and fat, mixed, meaning mucus, which make that these hydrons, this acid, can’t come back down. So, what does the hydrons being liberated produce? Something called a proton pump. Meaning they will use energy to liberate via this proton pump all of these hydrons and to push it far away from them, and they will have other transporters and other pumps for the bicarbonate. The proton pump makes it to be acid. The other transporters make it to be less acid the closer they are to the cells. And if all of a sudden there’s too much acid, they simply ask for more reinforcement through the blood, they get more bicarbonate, to neutralize the pH even more. Again, I would like to point out that this relationship between the blood vessel and the cells of the gastric mucus is very important. Likewise, if they ever need carbohydrates or lipids, the blood vessel will provide it for them, and these cells, once more, will produce mucus. Besides, if all of these were to fail, I mean, this is working all of the time, but if all of a sudden, by any cause, for example, we ate something extremely hot and then that damaged our cells, or we ingest a substance that’s toxic for the stomach and that damages our cells, what will our mucus cells do now to defend themselves? They will create, or liberate a substance that is a shield to them. These are called prostaglandins (PG). These prostaglandins let them know “you know what? Something is attacking us, something is hurting us” and that makes the proton pump to be inhibited and so they produce and liberate less acid, these prostaglandins also increase the amount of bicarbonate that they are going to produce, and the amount of mucus, again so that the acid doesn’t reach the mucus cells, or it reaches a bit less. And of course, if we have more bicarbonate and more mucus, we need an increased blood flow. So the prostaglandins reach the blood vessel, they open it, and we get more nutrients and substances to increase the protection our mucus cells have. This is, generally, the way our stomach works. In this way, the mucus and its integrity is going to be given by a balance between that harm them or have the potential to do so, and the things that protect them. For example, here we would have the bicarbonate, the mucus, and the prostaglandins, while in here we would basically have acid, and in some pathologic situations, here we could have some other substances, like meds, bilirubin, I mean bile, some bacteria, like Helicobacter pylori, other things. It’s when this balance is broken, and the damage is favored, we have 4 rocks here, instead of one and one, it’s when the damage is more intense than the repair and protection that we start having these tiny holes in our mucus, again, we create an ulcer; or we can even come to destroy blood vessels and even get a hemorrhage. What are then the causes that create damage? The most common ones are medications. Specifically Aspirin. Aspirin is one of the main causes by which we have stomach damage. Aspirin and also Nonsteroidal Anti-inflammatory Drugs(NSAIDs). What’s the mechanism of these? Why are they so harmful to the stomach? One is that they are meds which are directly acid. When we take them, acidity increases. Two, Aspirin and NSAIs can destroy the mucus that protects our mucus cells. Meaning they directly touch it and dissolve it in a way that it doesn’t work as well as it used to. So one for its acid properties destroys the bicarbonate; two by its properties, it destroys the mucus; and three, they block the synthesis of prostaglandins. In that way, the gastric mucus and the vessel that’s underneath it are completely destroyed with these meds. They are very good to take the fever away, to take the pain away, but they are very bad for the stomach. What are the meds included here? Well, for example Ibuprofen, Naproxen, Diclofenac, many of them are here, Aspirin; most of the ones we regularly use. There are other meds, specifically steroids, like corticoids; also, chemotherapy, and other meds. The second cause that’s very common, is an infection that’s in a lot of people is Helicobacter pylori, this is a bacteria that has learned to live inside of our stomachs, it basically hides among the cells and has many mechanisms to reduce acidity but at the same time, the bacteria produces inflammation because it destroys some of our mucus cells, it call on immune system cells, it creates a whole ruckus, a war, and these cells are destroyed. And in an important way, Helicobacter pylori are a cause of stomach cancer. In the third place, alcohol and other substances, specifically drugs, can also cause this. Radiation, especially when we are using it in high doses to treat a cancer, of course it can cause gastritis. For example, if we are treating cancer caused by helicobacter pylori, and I apply radiation, we have a double cause to have gastritis. Of course, if the blood vessels suffer damage, even if the mucus is in theory fine, well it of course won’t be able to protect itself, and we would also have gastritis. Lack of oxygen or trauma, meaning the patients who are in intensive care, who have very low blood pressure, or who are very grave in hospital, only because they are very ill, even if they don’t have anything else, this already is an important cause of gastritis, ulcers, and digestive tract hemorrhages. With food poisoning there are a lot of bacteria and many toxins in the food, which can cause gastritis. And of course, bile reflux, bile usually gets to the duodenum, the first portion of the small intestine, if by any reason it comes back up, if for example that sphincter, the pylorus, is malfunctioning, or we have any surgery that allows the bile to come back up, that is also an important cause of gastritis. And here we have it, the mucus gets destroyed, and it starts building these lesions. Here we have a duodenal ulcer, so the acid came here, which was in the stomach, it got to the first part of the small intestine, and it looks like this, just like a canker sore in the mouth, as if we had hit ourselves with the toothbrush, and we damage the mucus, well, it looks exactly the same, and many times it hurts exactly the same way, very intensely, with ardor, an ugly thing. This one is like one of the first phases, this is a starting ulcer, but if we continue, unlike here where there’s only mucus lesion, we can even get to damage the blood vessels, and then have a hemorrhage. If it’s a little one, maybe we don’t even notice it, and we have some manifestations, we have anemia, dizziness, but nothing else happens. If it’s a severe hemorrhage, it can cause situations in which we die because we lose so much blood through these lesions, again, this can specially happen in elder patients. Consequences What are the consequences, then? Of course, anemia, loss of volume, due to important hemorrhages. There are times when there is so much inflammation that the blood coagulates and this can generate an obstruction, that specially the duodenum gets clogged, which is way slimmer; of course dehydration, this dehydration and loss of electrolytes and everything we lose, can lead to a complete kidney failure, and also, in some cases, mainly when the gastritis is caused by Helicobacter pylori, it can lead to stomach cancer, which would be an extremely fatal circumstance. Who gets it? Well, of course people who consume NSAIs for a long time, once again, these are ketorolac, metamizole, aspirin, ibuprofen, all of those meds that we typically buy at the drugstore when we get a headache, all of them cause gastritis by their different mechanisms; also, the use of steroids and chemotherapy; the use of antiagregants, for example clopidogrel, but even antidepressants, the ones that inhibit the recapture of serotonin, can cause gastritis and they can also cause a greater risk of hemorrhage, mainly. Consuming alcohol often or in high doses can highly damage the mucus directly. Elder population is highly susceptible, given that their mucus doesn’t have as many mechanisms to protect itself, and the blood vessels don’t adapt as well to damage. An infection caused by helicobacter pylori is a very, very common cause, in fact a very high number of the population has this infection, which makes it really important for all of us to get checked. I won’t mention it much further because we’re going to make a video that’s specific to helicobacter pylori. And finally, like we established before, hospitalized patients in severe condition, who have a very dangerous thing for their bodies, besides the thing they have, they have the risk of having gastritis, of having an ulcer, and of having a gastrointestinal tract hemorrhage due to this thing we are seeing. Diagnosis Now, how do get to a diagnosis? Of course, it has to be a person who enters in the risk factor criteria, something of what we mentioned in the past slide, and there’s a lot to do to that person, exploration usually doesn’t tell us much, but the patient will have this non-specific pain, maybe it can’t be located accurately, if we find it, it’s usually in epigastrium, sometimes it runs to the back, and it has a burning sensation, basically it feels like the abdomen burns. Besides that, we can ask the patient and we can analyze, patients who already have bleeding can have either bloody vomit, or when they go to the toilet, the feces can be really dark, precisely because of the blood and hemoglobin they have in their discharges. So this is something that we always have to ask these patients, like “hey, when you go to the toilet you make really dark, like super black or very dark brown?” if the answer is yes, we have to start worrying, and then we can take laboratory samples, a complete blood count (CBC), to see how their hemoglobin is, to see that the patient is not losing blood; liver and kidney functions, to see that the other organs are working properly; and blood in the stool to see what we were saying, to see if they are already bleeding or not. We have to rule out other things that can give us a false positive in any of these symptoms, this pain in the abdomen, a low hemoglobin count, etc. and one of the most important ones will be pregnancy, obviously in patients who are in the correct age range and gender; but they can also be suffering from gallbladder or pancreatic disease. This is why, again, it’s very important to not only “oh, I have gastritis”, no. You have to get a complete checkup, and make sure that it’s not something else. For example to rule out that that gastritis could be a pregnancy we haven’t noticed. And of course, if it’s pregnancy, we can’t give that patient the same meds. We have to make tests to find the bacteria, Helicobacter pylori, there’s a test in stool, one in breath, and one in blood, but the more common are the ones in breath and in stool, since they are the easiest to take, and there’s many centers in which they take the tests, in a very fast and precise way, they can tell you if you have the infection, and once you get the treatment to eradicate it, they can also tell you if you are cured or not. And lastly, we can do an endoscopy. This would be for patients in a more advanced state, but it’s basically to pass a tube along the throat until it reaches the stomach, and once we are inside the stomach, we see how the mucus is, and if it’s necessary, we take a small sample to see what’s in there. In fact, the image I showed you in the past slides, the ones in which we saw the bleeding, and the ones where we can only see the lesion, the ulcer, those are endoscopy images. How bad is it? Now, how grave is it? The first thing that we need to know when someone has gastritis is to know how bad it is. And basically to determine the severity, the first thing that we need to know is if it’s bleeding or not. If it’s not bleeding, it’s usually a not very severe gastritis, and the patient shouldn’t be hospitalized. If it IS bleeding, then it usually is a severe gastritis, and it would require a more aggressive treatment, and many times, even hospitalization. But since it’s not so easy to determine, a scale was created to help, the Rockall scale. This scale tells me how probable it is that this patient gets complicated by this gastritis. You’ll remember that in the pneumonia video, which we posted not long ago (I’ll leave the link up here), we also had a scale to know if the patient needed hospitalization or if the patient can be assessed and treated at their home, the CURB-65, so this one’s just like the CURB-65, but called Rockall. So this scale will give us a score, it can be a 0, 1, 2, or 3, or even higher after we give the patient an endoscopy; and it has 3 main points: 1) The age of the patient, less than 60 is a low risk patient, from 60 to 79 there’s a higher risk since the stomach can’t defend itself, and more than 80 years old, this one is a high risk patient. 2) If the patient is or not in a shock state, this has two meanings, one being that the patient is crashing for some reason or another, for example he/she is in intensive care because they had a heart attack, so the patient is in shock and the stomach can’t defend itself, which of course makes it easier for things to get complicated, and that the patient dies; or two, the shock is directly caused by the gastritis, which of course means that the gastritis is a very dangerous one, but basically what we do to know if the patient is in shock or not, is to check their pulse, if the pulse is below a 100, or over 100, and we can have the blood pressure, if the systolic blood pressure, the higher one, is over 100 it’s ok, again, if it’s over 100 it’s still fine, even though here the patient has a pulse over 100, so we start worrying, and lastly if the pulse is over 100 and the pressure is below 100, we worry because it means that the heart is losing a lot of volume and can’t compensate anymore. Lastly, 3) Co-morbidity, if the patient, besides gastritis, already has another dangerous illness, of course he/she has a higher risk. Which are these dangerous diseases that lead you to a 2 score immediately? Well, it’s having cardiac insufficiency, having had heart attacks, diabetes, renal insufficiency, some type of cancer, etc. Afterwards, once the doctor has assessed the patient, we’ll do an endoscopy and that’ll give us more specifically how this patient is, if he/she is fine, if he/she is grave, and how dangerous this is. But again, to do at first the Rockall scale, we don’t need the endoscopy, just the age, the vital signs, which the more altered, the graver the patient is, and to know if the patient has another illness. In general terms, if the patient has any vital sign that’s altered, and has another pathology, even if it’s diabetes, we have to take that patient urgently to a doctor to be assessed. Here we have again the Rockall scale, in fact this is a calculator, a very good one, I’ll leave the link at the end of the video so you can enter the data of the patient, and so you can know if that patient needs a doctor urgently or not. We enter the data, we can put here with or without endoscopy, and it can show us how the patient is, a 0 in Rockall, the risk of bleeding, which is low, and the mortality, which is very low at .2%. But as we move forward, to 1 Rockall, or 2 Rockall, we can see that the bleeding risk increases, and the mortality can increase as well, only it’s very, very little, as you can see here, in fact the same data are here, it does increase, but it’s very low up till 2 Rockall. In fact, if we have Rockall 2 or lower, it’s usually unnecessary to be hospitalized. But when we reach Rockall 3, suddenly the risk of bleeding increases a lot, and more patients start to die, 2 in every 100; in Rockal 4 it’s 5 in every 100; Rockall 5 it’s 10 in every 100. And this of course, is for a patient in grave danger. And we can continue with this scale from there. Again, I’ll leave you the calculator at the end so you can assess someone if they have gastritis and you can know what that person needs. Treatment Now that we know that the person has gastritis, and we know how important or how urgent it’s to treat him/her, ok, now what will be treatment? Well, basically we have to treat the cause. We have to remove the thing that’s causing the gastritis. What can this be? We already saw the risk factors, but once again: 1) the base treatment, basically will be to administer an inhibitor of the proton pump. You remember that we said that the proton pump is what sends the hydrons or the acid inside of the stomach, so we administer a medication that blocks that pump, and won’t allow for the acid to be liberated. These medications are famous, I don’t even have to say the names, but it’s things like omeprazole, esomeprazole, lansoprazole, all of those. But they are the cornerstone in the treatment of gastritis. They are very good, they are relatively safe, though we always have to administer them with medical supervision, because they can probably cause bone disorders, they have been associated in some studies with Alzheimer, though not all of them, and with infections in upper airways, and other things. They are not completely harmless, we have to administer them with medical supervision, but they are pretty safe, and pretty effective for the treatment of gastritis, and that’s why they are the cornerstone of it. Other medications that can be administered, but that generally are not as used since have these that are much better, are sucralfate, especially when the patient is already bleeding and already had ulcers, and the H2 receptor blockers, for example, ranitidine. 2) In the event that the patient has an infection by Helicobacter pillory, and again, at this point we already have done the breath study or the stool study, we have to administer an inhibitor of the proton pump, plus two antibiotics, not one but two antibiotics. The most used ones are amoxicillin and clarithromycin, for a period of 14 days. So we combine the two antibiotics plus the inhibitor for 14 days, and with that we eradicate the bacteria, and of course, by the end of the treatment we retake the study, be it breath or stool, to determine if we cured the patient or not. We can also administer bismuth salts, like Pepto-Bismol, or Bismuth subsalicylate, which can be given even with the antibiotic treatment, and the inhibitor of the proton pump to favor the eradication of this bacteria. We have to suspend other medications and anticoagulants, and with other medications I refer specifically to Nonsteroidal Anti-inflammatory Drugs, and I repeat once more: naproxen, ketorolac, Ibuprofen, especially Aspirin, all of those. Antidepressants could be as well, obviously being careful of the other complications that may happen, for example, if the person’s taking the anticoagulant for a heart attack, we can’t suspend the medication just like that. If it’s really important, be it to make a diagnosis, or to stop a hemorrhage, we can do an endoscopy, of course at a hospital And besides the treatment, besides all that we mentioned earlier, we also have to give a special consideration to the diet of the patient. When we have gastritis, this diet has to avoid all irritants, fatty foods, alcohol, coffee, or tea, all of that has to be avoided for at least for two months after we diagnose gastritis. We must avoid spicy food and other irritants, like food that’s too salty. We have to eat fish, boiled fruits and vegetables, without the skin. You can consume non-fat dairies, and lean meats. Our diet should be constituted by these when we have gastritis to protect our stomach once again, and to help it not work as hard, and not throw as much acid and as many proteases to destroy and digest our food. And here I leave you all the bibliography, we took the information from here, so we have the Guide of Clinical Practice, Medscape, and this is the calculator for the Rockall index. I don’t mention here the bicarbonate, or the magnesium salts, directly, for example, which can also be used for gastritis, because this is only for non-complicated acute gastritis, these patients who suddenly have gastritis because they ate too much, or because they ate a lot of spicy foods, and use for example Alka-Seltzer after a big meal, they can be used, but they are treatments which are not very effective, but can be used as well. And lastly, I want to thank all of those who follow and support me on Patreon, with their subscription and the support they give us each month, thanks to you we have more and better content, thank you so much for all the support you’ve given us this year. Warm hugs. Ok, that’s all for today’s video, I hope you liked it and understood it, don’t forget to get checked, and as always, help us change the world, share information. Translation and subtitles by Elizabeth Ochoa

27 Replies to “¿Qué es la Gastritis?

  1. Gracias por tus videos!! Este es el que más me dio cosa ver.😰😰😰 Si se puede claro. Una explicación de como seguir comiendo chicharrón. Sin morir en el intento😁

  2. Brrrrr….!!!
    Excelente, como siempre..
    Tu puedes llegar a ser el nuevo Isacc Assimov….!
    Tienes talento, para ser Divulgador Cientifico..

    Lo dices de manera facil entendible, hasta para los huevones como yo
    (ks..ks..ks…, just kidding..!)

    Entiendo, que estos temas, la gente tiene miedo conocer, auque son muy
    importantes, por que la mejor cura, es la prevencion…!

    Conozco mucha gente que dice, prefiero ignorar, no quiere entrar a estos detalles
    por que se transforman en hipocondriacos.

    Como tus exposiciones, pueden convertise en metodos preventivos, de males..?
    Eso tienes que afinar la punteria..

    Personalmente, me gustaria conocer un poco mas de las afecciones del "Helico Bacter" ,
    como funcionan ese nuevo metodo de deteccion por respiracion…cuales son los
    mejores tratamientos.., si es que uno puede pedir a su medico "despistaje", sin que
    se sienta ofendido mi doctor…, para eso habria que tener algunos signos..,
    cuales son esos signos….?

    Tambien si, me permites, podria hacerte una sugerencia :
    Tu actual metodo es excelente, pero necesita tiempo para que la gente digiera
    estos temas, por que la gente ordinaria, simplemente siente panico…!

    Si esta, a tu alcance hacer tal vez, un poco de " Historia de la Medicina", asi como
    publicaciones de "Historia de la Medicina Legal", relacionados directamente con
    la evolucion de la "Ciencia Policial" , temas por si ..muy apasionantes.

    Por algo, los programas exitosos de Television, tienen 80 % de programacion Policial…
    Viste, el morbo de la gente..?

    Solo a unos cuantos, no gustan temas policiales – detectives – abogados – malandrines,
    estafadores..,etc, la mayoria de la gente critica , detesta y ama estos temas..!

    Hace años, pude ver un programa de la Tv alemana, (muy poco, por mis viajes) sobre la historia
    la medicina legal, como algunos crimenes pasaban por alto, como por ej. un carnicero asesino
    que eliminaba gente, pero nadie podia acusarlo de sus manchas de sangre.., hasta que un buen
    dia un quimico, descubre reactivos, que diferencian por el color, las manchas de sangre animal
    de las manchas de sangre humana..!

    O, los inflibles e indetectables metodos de asesinar impunemente con venenos, hasta que poco
    a poco en la medicina legal se introducen y utilizan nuevos reactivos, sueros, pruebas, etc, que
    determinan, cual es cual..,
    Ups.., el tema es inacabable….!!!

    Es solo un consejo…, una opinion muy personal..!

  3. Hola Doctor 👨‍⚕️ me gusta Cómo explica yo tengo Gastritis y medan unos Dolores de estómago muy Fuertes de ves en cuando y ya Me isieron una Indoscopia y Yo no como tanta grasa lo Evito, y mi doctor no me a Dicho nada y sigo tomando el Mismo medicina, q usted cre q Pueda ser? y se me junta Mucha flema, espero y me Conteste cracias azta luego A Dios.

  4. Hola Doctor 👨‍⚕️. mire le mencioné q cada ves q como luego del dolor de estómago se me a marga la boca, si tomo medicina para el Gastritis y también tengo fibromialgia y artritis y tengo depresión, usted tiene una idea de por q enseguida de lo q yo tomo, la mayoría del tiempo es pura agua q tomo y la boca me sigue quedando amarga tengo q comer algo dulce, este mensaje es para el Doctor: Sinapsis EMP. espero Su contestación a dios. y saludos a monterrey.

  5. Hola doctor, buenas tardes. A mi me da un dolor tremendo en la boca del estómago, pero se me quita con una ranitidina, cosa que no hace el omeprazol, este sólo me sirve para evitar el reflujo.. Entonces no se que tengo, porque el doctor no me ayuda…Por las mañanas me tomo un licuado verde: espinaca, pepino, nopal, apio, y usted dice que no hay que tomar con cáscara, está bien este licuado, porque lo tomo para el estreñimiento.(que dicho sea de paso no veo que me ayude), también me tomo aceite de oliva extra virgen está bien lo que estoy haciendo?–gracias…… Doctor espero me ayude por favor..no me ignore… ahhh también el dolor del estómago se me quita comiendo… gracias, gracias..

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